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UTAH STATUTORY FORM POWER OF ATTORNEY 
Utah Code Sections 75-9-101 et seq. 
 
IMPORTANT INFORMATION 

This power of attorney authorizes another person (your agent) to make decisions 
concerning your property for you (the principal). Your agent will be able to make 
decisions and act with respect to your property (including your money) whether or not 
you are able to act for yourself. The meaning of authority over subjects listed on this 
form is explained in Title 75, Chapter 9, Uniform Power of Attorney Act.  

This power of attorney does not authorize the agent to make health care decisions for 
you.  

You should select someone you trust to serve as your agent. Unless you specify 
otherwise, generally the agent's authority will continue until you die or revoke the power 
of attorney, or the agent resigns or is unable to act for you.  

Your agent is entitled to reasonable compensation unless you state otherwise in the 
Special Instructions.  

This form provides for designation of one agent. If you wish to name more than one 
agent you may name a co-agent in the Special Instructions.  

Co-agents are not required to act together unless you include that requirement in the 
Special Instructions. If your agent is unable or unwilling to act for you, your power of 
attorney will end unless you have named a successor agent.  

You may also name a second successor agent. This power of attorney becomes 
effective immediately unless you state otherwise in the Special Instructions.  

If you have questions about the power of attorney or the authority you are 
granting to your agent, you should seek legal advice before signing this form. 

 
DESIGNATION OF AGENT 
 

I ____________________________________________________ (Name of Principal) 
name the following person as my agent: 

Name of Agent: _________________________________________________________ 

Agent's Address: ________________________________________________________ 

Agent's Telephone Number: _______________________________________________ 

f my agent is unable or unwilling to act for me, I name as my successor agent:  

Name of Successor Agent: ________________________________________________ 

Successor Agent's Address: _______________________________________________ 

Utah Statutory Form Power of Attorney 
Utah Code 75-9-101 et seq. 

May 2016 
Rev. December 10, 2018 

 

Page 1 of 6 

 

  I

 

Successor Agent's Telephone Number: ______________________________________ 

f my successor agent is unable or unwilling to act for me, I name as my second 
successor agent:  

Name of Second Successor Agent: _________________________________________ 

Second Successor Agent's Address: ________________________________________ 

Second Successor Agent's Telephone Number: _______________________________ 

GRANT OF GENERAL AUTHORITY 

I grant my agent and any successor agent general authority to act for me with respect to 
the following subjects as defined in Title 75, Chapter 9, Uniform Power of Attorney Act:  

(INITIAL each subject you want to include in the agent's general authority. If you wish to grant general 
authority over all of the subjects you may initial "All Preceding Subjects" instead of initialing each subject.) 
 

[      ]  Real Property  
[      ]   Tangible Personal Property 
[      ]   Stocks and Bonds 
[      ]   Commodities and Options 
[      ]   Banks and Other Financial Institutions 
[      ]   Operation of Entity or Business 
[      ]   Insurance and Annuities 
[      ]   Estates, Trusts, and Other Beneficial Interests 
[      ]   Claims and Litigation 
[      ]   Personal and Family Maintenance 
[      ]   Benefits from Governmental Programs or Civil or Military Service 
[      ]   Retirement Plans 
[      ]   Taxes 
[      ]   All Preceding Subjects 

   

   

GRANT OF SPECIFIC AUTHORITY (OPTIONAL) 

My agent MAY NOT do any of the following specific acts for me UNLESS I have 
INITIALED the specific authority listed below:  

CAUTION: 
Granting any of the following will give your agent the authority to take actions 
that could significantly reduce your property or change  
how your property is distributed at your death. 
INITIAL ONLY the specific authority you WANT to give your agent. 

[      ]  Create, amend, revoke, or terminate an inter vivos trust 

Utah Statutory Form Power of Attorney 
Utah Code 75-9-101 et seq. 

May 2016 
Rev. December 10, 2018 

 

Page 2 of 6 

  I

   

 

[      ]   Make a gift, subject to the limitations of Section 75-9-217, and any special 

instructions in this power of attorney     

[      ]   Create or change rights of survivorship      
[      ]   Create or change a beneficiary designation   
[      ]   Authorize another person to exercise the authority granted under this power 

of attorney   

[      ]   Waive the principal's right to be a beneficiary of a joint and survivor annuity, 

including a survivor benefit under a retirement plan  

[      ]   Exercise fiduciary powers that the principal has authority to delegate   
[      ]   Disclaim or refuse an interest in property, including a power of appointment    

   

LIMITATION ON AGENT'S AUTHORITY 

An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to 
benefit the agent or a person to whom the agent owes an obligation of support unless I 
have included that authority in the Special Instructions.   

SPECIAL INSTRUCTIONS (OPTIONAL) 

ou may give special instructions on the following lines: 

 
EFFECTIVE DATE 
 

Utah Statutory Form Power of Attorney 
Utah Code 75-9-101 et seq. 

May 2016 
Rev. December 10, 2018 

 

Page 3 of 6 

    

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This power of attorney is effective immediately unless I have stated otherwise in the 
Special Instructions.     

 
NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL) 

If it becomes necessary for a court to appoint a conservator of my estate or guardian of 
my person, I nominate the following person(s) for appointment:    

ame of Nominee for conservator of my estate: _______________________________ 

Nominee's Address: _____________________________________________________ 

Nominee's Telephone Number: ____________________________________________ 

ame of Nominee for guardian of my person: _________________________________ 

Nominee's Address: _____________________________________________________ 

Nominee's Telephone Number: ____________________________________________ 

RELIANCE ON THIS POWER OF ATTORNEY 

 

Any person, including my agent, may rely upon the validity of this power of attorney or a 
copy of it unless that person knows it has terminated or is invalid. 

 
SIGNATURE AND ACKNOWLEDGMENT 

Your Signature: _________________________________________________________ 

Date: _________________________________________________________________ 

Your Name Printed: _____________________________________________________ 

Your Address: __________________________________________________________ 

Your Telephone Number: _________________________________________________ 

On this date, I certify that _________________________________________________________ (name) 
who is known to me or who presented satisfactory identification, in the form of 
______________________________________________________ (form of identification), has, while in my 
presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. 

Typed or printed name (Notary Public) 

Sign here ► 

Notary Seal 

 

 

 

Utah Statutory Form Power of Attorney 
Utah Code 75-9-101 et seq. 

May 2016 
Rev. December 10, 2018 

 

Page 4 of 6 

  N

  N

 
Date 

 

 

[ This document prepared by: _____________________________________________ ] 

   

IMPORTANT INFORMATION FOR AGENT 
 
AGENT’S DUTIES 
 

When you accept the authority granted under this power of attorney, a special legal 
relationship is created between you and the principal. This relationship imposes upon 
you legal duties that continue until you resign or the power of attorney is terminated or 
revoked. You shall:  
 

(1) do what you know the principal reasonably expects you to do with the principal's 
property or, if you do not know the principal's expectations, act in the principal's 
best interest;   
(2) act in good faith;   
(3) do nothing beyond the authority granted in this power of attorney; and  
(4) disclose your identity as an agent whenever you act for the principal by writing or 
printing the name of the principal and signing your own name as "agent" in the 
following manner:  (Principal's Name) by (Your Signature) as Agent 

nless the Special Instructions in this power of attorney state otherwise, you must also:  

(1) act loyally for the principal's benefit;  
(2) avoid conflicts that would impair your ability to act in the principal's best interest;   
(3) act with care, competence, and diligence; 
(4) keep a record of all receipts, disbursements, and transactions made on behalf of 

the principal;  

(5) cooperate with any person that has authority to make health care decisions for 
the principal to do what you know the principal reasonably expects or, if you do 
not know the principal's expectations, to act in the principal's best interest; and  

(6) attempt to preserve the principal's estate plan if you know the plan and 
preserving the plan is consistent with the principal's best interest.  

TERMINATION OF AGENT’S AUTHORITY 
 
You must stop acting on behalf of the principal if you learn of any event that terminates 
this power of attorney or your authority under this power of attorney. Events that 
terminate a power of attorney or your authority to act under a power of attorney include: 
  
 

(1) death of the principal; 
(2) the principal's revocation of the power of attorney or your authority; 
(3) the occurrence of a termination event stated in the power of attorney; 
(4) the purpose of the power of attorney is fully accomplished; or 

Utah Statutory Form Power of Attorney 
Utah Code 75-9-101 et seq. 

May 2016 
Rev. December 10, 2018 

 

Page 5 of 6 

  U

  

 

 

(5) if you are married to the principal, a legal action is filed with a court to end your 
marriage, or for your legal separation, unless the Special Instructions in this 
power of attorney state that such an action will not terminate your authority. 

 
LIABILITY OF AGENT 
 

The meaning of the authority granted to you is defined in Title 75, Chapter 9, Uniform 
Power of Attorney Act. If you violate Title 75, Chapter 9, Uniform Power of Attorney Act, 
or act outside the authority granted, you may be liable for any damages caused by your 
violation.  

f there is anything about this document or your duties that you do not 
understand, you should seek legal advice. 

Utah Statutory Form Power of Attorney 
Utah Code 75-9-101 et seq. 

May 2016 
Rev. December 10, 2018 

 

Page 6 of 6 

 

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Utah Statutory Form Power of Attorney

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 6
Fields(s): 228
Average fields per page: 38
Reading Level: Grade 12
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

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